Prudential uses this supplemental statement to update an open group disability claim with the attending physician's current findings. It asks for clinical diagnoses with required ICD codes, pregnancy EDC and delivery date, the date significant loss of function occurred, claim type, other treating physicians, tests and procedures, treatment and prognosis, hospital stays, a return-to-work target and plan, medical and non-medical obstacles, and the job category matching the patient's abilities.
The attending physician completes Sections 2 to 4 and signs the fraud certification. Prudential identifies the claimant by name and claim number.
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Supplemental Attending Physician's Statement
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Yes. The diagnosis box states that an ICD code is required for the primary and secondary clinical diagnoses. The form also asks for the date when significant loss of function occurred, which Prudential uses alongside the diagnosis to place the claim on a timeline.
Section 3 asks for a return-to-work target date, full-time or part-time, with any limitations or functions lost, a description of the return-to-work plan, medical obstacles to returning, the nature of the impairment, and the job category that best describes the employee's functional abilities.